General practitioner


A general practitioner is a doctor who is a specialist in general practice. GPs have distinct expertise and experience in providing whole person medical care, whilst managing the complexity, uncertainty and risk associated with the continuous care they provide. By contrast with specialist physicians, GPs do not have a specific specialist area; they can diagnose and treat many different conditions, while also determining when a patient needs to see a doctor with more specialist training in a particular area & generally participate moreso in outpatient care as opposed to inpatient care. The term primary care physician is used in the United States.
GPs work at the heart of their communities, striving to provide comprehensive and equitable care for everyone, taking into account their health care needs, stage of life and background. GPs work in, connect with and lead multidisciplinary teams that care for people and their families, respecting the context in which they live, aiming to ensure all of their physical health and mental health needs are met. They are trained to treat patients to levels of complexity that vary between countries.
A core element in general practice is continuity of care, that bridges episodes of various illnesses over time. Greater continuity with a general practitioner has been shown to reduce the need for out-of-hours services and acute hospital admittance. Continuous care by the same general practitioner has been found to reduce mortality.
The role of a GP varies between and within countries, and is often dependent on local needs and circumstances. In urban areas their roles may focus on:
In rural areas, a GP may additionally be routinely involved in pre-hospital emergency care, the delivery of babies, community hospital care and performing low-complexity surgical procedures. GPs may work in larger primary care centers where they provide care within a multidisciplinary healthcare team, while in other cases GPs may work as sole practitioners or in smaller practices.
The term general practitioner or GP is common in the United Kingdom, Republic of Ireland, Australia, Canada, Singapore, South Africa, New Zealand and other Commonwealth countries. In these countries, the word "physician" is largely reserved for medical specialists often working in hospitals, notably in internal medicine. In North America, general practitioners are primary care physicians, a role that family doctors and internists occupy as well, though the American Academy of General Physicians, the American Academy of Family Physicians, and the American College of Physicians are distinct entities representing these three respective fields.
General practice is an academic and scientific discipline with its own educational content, research, evidence base and clinical activity. Historically, the role of a GP was performed by any doctor with qualifications from a medical school working in the community. However, since the 1950s, general practice has become a medical specialty with additional training requirements. The 1978 Alma Ata Declaration set the intellectual foundation of primary care and general practice.

Indian subcontinent

India

The basic medical degree in India is MBBS. These generally consist of a four-and-a-half-year course followed by a year of compulsory rotatory internship in India. The internship requires the candidate to work in all departments for a stipulated period of time, to undergo hands-on training in treating patients.
The registration of doctors is usually managed by state medical councils. A permanent registration as a Registered Medical Practitioner is granted only after satisfactory completion of the compulsory internship.
The Federation of Family Physicians' Associations of India is an organization which has a connection with more than 8000 general practitioners through having affiliated membership.

Bangladesh

In Bangladesh, the completion of a 5-year MBBS program is succeeded by a one-year rotational internship encompassing various specialties. Bangladesh Medical & Dental Council then provides permanent registration to the doctors, after which the candidate may choose to practice as a GP or opt for specialty training.. As of 2019, there are some 86,800 doctors, and dentists registered with the BM&DC.
Bangladesh College of Physicians and Surgeons has a one-year membership and four-year fellowship program in Family Medicine.

Pakistan

In Pakistan, 5 years of MBBS is followed by one year of internship in different specialties. Pakistan Medical and Dental Council then confers permanent registration, after which the candidate may choose to practice as a GP or opt for specialty training.
The first Family Medicine Training programme was approved by the College of Physicians and Surgeons of Pakistan in 1992 and initiated in 1993 by the Family Medicine Division of the Department of Community Health
Sciences, Aga Khan University, Pakistan.
Family Medicine residency training programme of Ziauddin University is approved for Fellowship in Family Medicine.

Europe

European Union

General practitioners are regulated in the EU by Directive 2005/36/EC.

France

In France the médecin généraliste is responsible for primary care medicine, including non-vital emergencies and patient's follow up. This implies prevention, education, care of the diseases and traumas. The general practitionner orientates the patients to other specialists when necessary.
They have a role in the survey of epidemics, a legal role, and a role in the emergency care. They often go to a patient's home when the patient cannot come to the consulting room, and have to contribute to night and week-end duties.
The studies consist of six years at university, and four years as a resident :
  • the first year is common with the dentists, pharmacists and midwives. The rank at the final competitive examination determines in which branch the student can choose to study.
  • the following two years, called propédeutique, are dedicated to the fundamental sciences: anatomy, human physiology, biochemistry, bacteriology, statistics...
  • the three following years are called externat and are dedicated to the study of clinical medicine; they end with a classifying examination, the rank determines in which specialty the student can make her or his internat;
  • the internat is three years -or more depending on the specialty- of initial professional experience under the responsibility of a senior; the interne can prescribe, s/he can replace physicians, and usually works in a hospital.
This ends with a doctorate, a research work which usually consist of a statistical study of cases to propose a care strategy for a specific condition.

Greece

General Practice was established as a medical specialty in Greece in 1986. To qualify as a General Practitioner doctors in Greece are required to complete four years of vocational training after medical school, including three years and two months in a hospital setting. General Practitioners in Greece may either work as private specialists or for the National Healthcare Service, ESY.

Netherlands and Belgium

General practice in the Netherlands and Belgium is considered advanced. The huisarts administers first line, primary care. In the Netherlands, patients usually cannot consult a hospital specialist without a required referral. Most GPs work in private practice although more medical centers with employed GPs are seen. Many GPs have a specialist interest, e.g. in palliative care.
In Belgium, one year of lectures and two years of residency are required. In the Netherlands, training consists of three years of specialization after completion of internships of 3 years. First and third year of training takes place at a GP practice. The second year of training consists of six months training at an emergency room, or internal medicine, paediatrics or gynaecology, or a combination of a general or academic hospital, three months of training at a psychiatric hospital or outpatient clinic and three months at a nursing home or clinical geriatrics ward/policlinic. During all three years, residents get one day of training at university while working in practice the other days. The first year, a lot of emphasis is placed on communications skills with video training. Furthermore, all aspects of working as a GP gets addressed including working with the medical standards from the Dutch GP association NHG.
All residents must also take the national GP knowledge test twice a year. In this test of 120 multiple choice questions, medical, ethical, scientific and legal matters of GP work are addressed.

Spain

In Spain GPs are officially especialistas en medicina familiar y comunitaria but are commonly called "médico de cabecera" or "médico de familia". It was established as a medical specialty in Spain in 1978.
Most Spanish GPs work for the state-funded health services provided by the county's 17 regional governments. They are in most cases salary-based healthcare workers.
For the provision of primary care, Spain is currently divided geographically in basic health care areas, each one containing a primary health care team. Each team is multidisciplinary and typically includes GPs, community pediatricians, nurses, physiotherapists and social workers, together with ancillary staff. In urban areas all the services are concentrated in a single large building while in rural areas the main center is supported by smaller branches, typically single-handled.
Becoming a GP in Spain involves studying medicine for 6 years, passing a competitive national exam called MIR and undergoing a 4-year training program. The training program includes core specialties as general medicine and general practice, pediatrics, gynecology, orthopedics and psychiatry. Shorter and optional placements in ENT, ophthalmology, ED, infectious diseases, rheumathology or others add up to the 4 years curriculum. The assessment is work based and involves completing a logbook that ensures all the expected skills, abilities and aptitudes have been acquired by the end of the training period.